Helping immigrants navigate the health care system

By Sharon Gray

Medical students at Memorial are helping to improve access to
medical care for the refugee population of St. John’s through
the Gateway project.

Started in 2006, this project pairs first and second-year
medical student volunteers with a newly-arrived refugee client of
the Association for New Canadians (ANC) plus his or her translator.
The student takes a medical history, summarizes the history into a
two-page report, forwards the report to a doctor previously
recruited to take on refugee clients, makes an appointment for the
client and sends that information to the family doctor for the
appointment. The ANC social worker then follows up with clients
after their appointment to make sure their introduction to their
new family doctor went smoothly.

It took a great deal of work to get the project off the ground.
During the 2005-2006 school year, Monica Kidd and Yoella Teplitsky,
then in their second year of medical studies, started exploring the
idea of a community initiative to benefit new immigrants. Training
in history taking with refugees and cross-cultural health care was
already in place through Clinical Skills and Medical Ethics, and it
was that course content that led to the idea for the Gateway
project.

With the support of Drs. Pauline Duke and Fern Brunger, who were
teaching cross-cultural training as part of Clinical Skills and
Medical Ethics to first and second-year students, and Dr. James
Rourke, Dean of Medicine, a proposal was developed to help
newly-arrived refugees find family physicians. Dr. Brunger is in
charge of overall planning and evaluation of the project while Dr.
Duke co-ordinates the program itself.

Dr. Gerard Farrell, assistant dean for Undergraduate Medical
Studies, was later added as a third faculty adviser. Dr.
Duke’s experience as a family physician and clinical skills
teacher with a long experience of working with newcomers to Canada,
coupled with Dr. Brunger’s academic focus son cross-cultural
issues in ethics, was complemented by Dr. Farrell’s expertise
with database development and privacy assurance.

In mid-February of 2006, Monica and Yoella worked with the
College of Physicians and Surgeons of Newfoundland and Labrador to
sort out a number of legal issues surrounding setting up the
program. A letter of support was obtained from the Dean of Medicine
to the effect that the university would take ownership of the
project and that it was part of undergraduate medical
education.

The project was officially named “Gateway” on March
1, 2006. The name was later modified to be officially called the
MUN Med Gateway project to distinguish it from other similar groups
operating under the name Gateway.

In Early June of 2006 the first interviews were held with
refugees. The first interviews were conducted by two groups of two
students. Each group conducted two interviews back-to-back with
refugees. The project only operated in 2006 for a few weeks before
school ended for the year, but medical student Megan Smith was
hired to continue work on it through a Summer Undergraduate
Research Award.

In early November of 2006, Sara Cutler and Andrea Weirathmueller
were elected from the first year class to be assistant
co-ordinators to Megan. They later took up responsibility as
co-ordinators for the 2007-2008 year.

The co-ordinators for 2008-2009 are Anna Sanderson and Karen
Downton.

Anna explained a significant move forward for the Gateway
project was the creation of a new electronic database to help with
research and confidentiality. Karen added that this was a
significant improvement and was implemented during the training of
new volunteers from the first-year medical students.

Research assistant Jeff Falardeau was hired on a part-time basis
in 2008 to revamp forms for the project, develop a
co-ordinator’s package, and complete an evaluation of the
initial two pilot years of the project.

From the point of view of the Association of New Canadians, the
Gateway project has proved an invaluable resource. “I think
it is a wonderful project,” said Ashley Crocker, a settlement
worker with the ANC. “We really appreciate the
professionalism, friendliness and kindness of the student
volunteers. And the feedback from our clients is 100 per cent
positive.”

Laura Mullally, the settlement social worker with the ANC, said
the Gateway project has been a wonderful collaboration. “Many
of our clients have had limited or unequal access to medical
treatment in their countries of origin. The care and attention that
they receive from the medical students through Gateway is therefore
greatly appreciated. Also some families are large or have more
complex medical histories and the Gateway program is a way to have
a more complete history taken, especially since many family doctors
have busy practices.”

Barbara Albrechtsons, a public health nurse with Eastern Health,
is also involved in the Gateway project. “My role is in the
obtaining of information on vaccinations and communicable disease
history from the Gateway interviews. I am in a new role at the
Association of New Canadians and provide referral and information
regarding health resources for immigrants and refugees. I believe
that the medical students provide a great resource. They have a
keen interest in the families they see and refer to a family
physician. I know the families seen by Gateway volunteers will be
off to a good start.”

The future looks bright for the Gateway project. A list of
family doctors in St. John’s willing to work with refugees
has been compiled. Discussions with Dean Rourke have led additional
support to the project in the form of funds for hiring a part-time
co-ordinator and assisting with the collection and storage of the
information. After a visioning year and two years of piloting, the
Gateway project is now an established volunteer program for medical
students at Memorial University.